While working for the Tokyo newspaper Nichinichi in 1908, Okamoto wrote his first play, Ishin Zengo, for the actor Ichikawa Sadanji II and his Kabuki group. He continued writing historical dramas (jidaimono), which were noted for their historical accuracy and poetic expression. Some of the best remembered are Shuzenji monogatari, Muromachi gosho, Sasaki Takatsuna, Toribeyama shinjū, and Banchō Sarayashiki. In his later years he wrote plays with situations taken from daily life (sewamono), such as the popular Sōma no Kinsan.

In 1937 Okamoto became the first dramatist to be made a member of the Art Academy and has since been considered the representative writer of what has been called the New Kabuki (Shin Kabuki). He also wrote more than 100 short stories and several novels, the most popular being Hanshichi torimono-chō, a recounting of cases handled by a detective Hanshichi, of the Tokugawa shogunate.